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Permit Y L CITY TIGARD MECHANICAL PERMIT DEVELOPMENT SERVICES PERMIT #: MEC2005 -00792 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 12/2/2005 PARCEL: 2S103DA -02202 SITE ADDRESS: SW NO ADDRESS ZONING: R -3.5 SUBDIVISION: DERRY DELL PLAT 2 LOT: 023 JURISDICTION: TIG Project Description: 2S103DA- 02202. PROPERTY ACCESSED AT 10895 SW DERRY DELL. Suspended Heater & gas piping. CLASS OF WORK: OTR FLOOR FURN: EVAP COOLERS: TYPE OF USE: U UNIT HEATERS: VENT FANS: OCCUPANCY GRP: VENTS W/O APPL: VENT SYSTEMS: STORIES: BOILERS /COMPRESSORS HOODS: FUEL TYPES 0 - 3 HP: DOMES. INCIN: 3 - 15 HP: COMML. INCIN: MAX INPUT: BTU 15 - 30 HP: FIRE DAMPERS ?: 30 - 50 HP: REPAIR UNITS: GAS PRESSURE: 50 + HP: WOODSTOVES: FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS: FURN > =100K BTU: <= 10000 cfm: OTHER UNITS: 1 > 10000 cfm: GAS OUTLETS: 1 Owner: FEES JOHN BALL Description Date Amount 2047 WEMBLEY PL [MECH] Permit Fee 12/2/200E $72.50 LAKE OSWEGO, OR 97034 [TAX] 8% State SurcharE 12/2/200E $5.80 Phone: 503- 635 -4158 Total $78.30 Contractor: SUPERIOR GAS CORPORATION 11380 N WESTSIDE RD REQUIRED ITEMS AND REPORTS CARLTON, OR 97111 Phone: 503- 852 -4492 Reg #: LIC 102250 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC by calling 503 - 246 -6699 or 1- 800 - 332 -2344. Issued By: --- 3X - 7.0_,7_,> . ../7; — , Permittee Signature: C� Call 503 - 639 -4175 by 7:00 a.m. for inspections th.t-business d y. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. • Mechanical Permit Application.. FOR OFFICE USE ONLY Received City of Tigard Date/By. /' - `.L � Permit No.: " OD 13125 SW Hall Blvd., Tigard, OIL 91 Plan Review Phone: 503.639.4171 Fax: 503.598.1960 Ga /ri1r + '', Date /By Other Permit: Inspection Line: 503.639.4175 OED 2 J 2005 t k 'i ,l C Date y: MI Supplemental See Page 2 for Internet: www.ci,tigard.or.us J Notified/Meted/Met hod: Supplemental Information CITY OF TIIGARD t I U11'a t iL "WgR` "� COMMERCIAL FEE* SCHEDULE - USE CHECKLIST Mechanical permit fees' are based on the value of the work El New construction ❑ Addition/alteration/replacement performed. Indicate the value (rounded to the nearest dollar) of all ❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit. CATEGORY OF CONSTRUCTION Value: $ RESIDENTIAL EQUIPMENT / SYSTEMS FEES* ❑ 1- and 2- family dwelling ❑ CommerciaUindustrial ❑ Accessory building . For special information use checklist. ❑ Multi - family ❑ Master builder ❑ Other: Description I Qty. 1 Ea. I Total JOB SITE INFORMATION AND LOCATION. Heating /cooling 130 Air conditioning or heat pump Job site address: air AMP , - ` dam (requires site plan showing placement) 14.00 City/State/ZIP: /� ►� ) ° (� >u�2ti5 T( Furnace 100,000 BTU (ducts/vents) 14.00 ( Furnace 100,000+ BTU (ducts/vents) 17.90 Suite/bldg. /apt. no.: Project name: Gas heat pump 14.00 Cr ss street /directions to job site: Duct work 14.00 Hydronic hot water system • 14.00 ( +�.A-�� al" (o V S Su-) Residential boiler (radiator or T 4 . a A ' , hydronic) J •A J Unit heaters (fuel -type, not electric), f 14.00 in -wall, in -duct, suspended, etc. ( 10.00 Flue /vent for any of above 10.00 Subdivision: Lot no.: Other: 10.00 Tax map /parcel no.: ;6/6, 3- - - d '�9-0 2 Other fuel appliances DESCRIPTION OF WORK Water heater 10.00 Gas fireplace 10.00 Q -- -$ pl P /av - rO O®z FTo Flue vent for water heater or gas ° t � fireplace 10.00 ` - Log lighter (gas) 10.00 Wood/pellet stove 10.00 Wood fireplace /insert 10.00 ❑ PROPERTY OWNER I ❑ TENANT Chimney /liner /flue/vent 10.00 Other: _ 10.00 Name: c - 4 W* C.e.._ Environmental exhaust and ventilation n ,. 2 Range hood/other kitchen Address: L4 ef 7 4C '✓I. UG(f 7' ( ?L . equipment 10.00 City /State /ZIP: ti 4- !J �., Q� , ( & Clothes dryer exhaust 10.00 �' Single -duct exhaust (bathrooms, Phone: (k, 63,.5,_ 5// .6- g Fax: ( ) toilet compartments, utility rooms) 6.80 •. ❑ APPLICANT ❑ CONTACT PERSON Attic/crawlspace fans 10.00 Business name: Other: 10.00 Fuel piping Contact name: $5.40 for first four; $1.00 for each additional Address: Furnace, etc. Gas heat pump City /State /ZIP: Wall /suspended/unit heater ( Phone: ( ) Fax: : ( ) Water heater Fireplace E -mail: Range • CONTRACTOR Barbecue � nc' ( Da, 64 Q � Clothes dryer (gas) Business name: tj ' �' Other: Address: I ) 3cA \N „tors) A e . Z4.1. MECHANICAL PERMIT City /State /ZIP: C AA-0 (--- 9 -7 / / ) Subtotal Phone: (.5-03 3(0 i. CD /7 Fax: ( ) Minimum permit fee ($72.50) 7�•`' 0 Plan review (25% of permit fee) CCB lic.: `® 22 / 9 • 7 State surcharge (8% of permit fee) y . (4 O TOTAL PERMIT FEE 7� This permit application e xpires if a permit is not obtained within 8 'r Authorized signature: `%C days after it has been accepted as complete. Print name: je) 34 t_ . Date: (2 - 2 ^ © • Fee methodology set by Tri- County Building Industry Service Board i:\Building\PemiirsVMEC- PennitApp.doc 12/03 440-46I7T (I l /02/COM/WEB) Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial Fee Schedule: Total Valuation: Permit Fee: $1.00 to $2,000.00 Minimum fee $72.50 $2,001.00 to $5,000.00 $72.50 for the first $2,000.00 and $2.30 for each additional $100.00 or fraction thereof, to and including $5,000.00. $5,001.00 to $10,000.00 $141.50 for the first $5,000.00 and $1.80 for each additional $100.00 or fraction thereof, to and including $10,000.00. $10,001.00 to $50,000.00 $231.50 for the first $10,000.00 and $1.35 for each additional $100.00 or fraction thereof, to and including $50,000.00. $50,001.00 to $100,000.00 $771.50 for the first $50,000.00 and $1.25 for each additional $100.00 or fraction thereof, to and including $100,000.00. $100,000.01 and up $1,396.50 for the first $100,000.00 and $1.10 for each additional $100.00 or fraction thereof Note: All new commercial buildings require 2 sets of plans. i: Building \Permits\MEC- PermitApp.doc 12/03 2 CITY OF TIE ARD BUILDING DIVISION PERMIT #: MEC2005-00792 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 12/2/200 Phone: (503) 639-4171 Inspection Requests (24 Hrs.): (503) 639-4175 INSPECTION WORKSHEET FOR DATE: 12/14/2005 TIME: 7:01AM PAGE: 23 SITE ADDRESS: SW NO ADDRESS CLASS OF WORK: SUBDIVISION: DERRY DELL PLAT 2 LOT #: 023 TYPE OF USE: PROJECT NAME: BALL DESCRIPTION: 2S103DA-02202. PROPERTY ACCESSED AT 10895 SW DERRY DELL. Suspended Heater & gas piping. OWNER: BALL, JOHN PHONE #: 503-635-4158 CONTRACTOR: SUPERIOR GAS CORPORATION PHONE #: 503-852-4492 Inspection Request Scheduled For: Date: 12/14/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 699 Mechanical final 023475-01 503-310-0176 (/6 Corrections/Comments/Instructions: (2 . 17 I E PARTIAL APPROVAL 0 CANCEL 0 NO ACCESS I I FAIL CALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED Inspector: • Date: Phone #: (503) 718-